Category Archives: Health Care

Virginia Ranks 40th of 53 in Nursing Home Ratings

by Carol J. Bova

One of three nursing homes receiving Medicare payments in Virginia (35.3%) scored below average or much below average in the latest Medicare ratings found in the new Care Compare website.

On February 1, 2021, the Centers for Medicare and Medicaid (CMS) updated its ratings report for nursing homes in the United States, District of Columbia, Puerto Rico and Guam. Compared to the ratings before the COVID-19 pandemic, Virginia has reduced the number of facilities with the low 1- and 2-star ratings. Still, Virginia nursing homes ranked 40th of 53 for below and much below average overall quality.

Nursing Home Ratings by State

Who owns these nursing homes? Continue reading

Fairy Tales, Absurdities, and COPN

by James C. Sherlock

We read in the Virginian-Pilot yesterday this statement from columnist Gordon Morse: “Covering indigent care and doing so in ways that do not undermine the entire health care system is central to the existence of COPN.”

In his column, he moved on to this common and reductio-ad absurdum corollary: “You can, as an alternative to COPN (or any regulatory structure), just throw it wide open and see what happens.”

Mr. Morse’s narrative about COPN — repeated endlessly by the law’s supporters — is that without COPN, poor people would be left to die on hospital steps. The story captures the hearts and votes.  It has worked for nearly 50 years and works today. 

Morse has been around forever and should know better. The fact is, COPN and healthcare facility licensing are separate sets of regulations in Virginia. Care for the poor does not depend upon COPN. At all. Never did.

Undeterred, Morse plays the compassion card face up. COPN supporters have no other card to show in polite company. Continue reading

Virginia’s Covid Vaccination Plan – Nothing to Exercise

by James C. Sherlock

I have read a lot of speculation here on who is responsible for the mess that has been the distribution and administration of COVID vaccines.

I will try offer some clarification.

On a day-to-day basis, people get flu shots or shingles shots or whatever from a lot of different providers. The normal pharmaceutical distribution system handles the supply chain.

Emergency planning guidance for pandemic emergency distribution and administration of vaccines is contained in Virginia’s famously shy Emergency Operations Plan – HAZARD-SPECIFIC ANNEX #4 PANDEMIC INFLUENZA RESPONSE of 2012.

Planning assumptions included:

– Pre-event planning is critical to ensure a prompt and effective response to a pandemic influenza, as its spread will be rapid, recurring (in multiple waves), and difficult to stop once it begins. …
– Vaccines will not be available for approximately six months following identification of the virus and will be in limited quantities when made available, necessitating the need to develop and implement a distribution plan.

Policies: Continue reading

Private Sector Screws Up Vaccine Dispersal

By Peter Galuszka

For more than a year, there has been a stream of criticism of government handling of the COVID vaccine.

On this blog, there has been a relentless pounding of Gov. Ralph Northam for his role in trying to navigate the pandemic that has so far killed more than 500,000 Americans. This is a far greater number than all of U.S. troops killed in World War II.

Now, two members of Congress, both moderate Democrats, are raising questions about the current system of providing vaccines. The private sector has a lot to answer for.

According to U.S. Rep. Abigail D. Spanberger (7th District) and Rep. Elaine G. Luria (2nd District), the current system is confusing, as large pharmacy companies CVS and Walgreen try to handle giving people protective shots.

Of special note is their concern that the current system favors the rich over the poor. In their letter to Dr. Rochelle Walensky, director of the Centers fort Disease Control and Protection, they wrote:

“Unfortunately, the complicated array of programs has caused significant confusion and frustration for public health officials and the general public. The varied eligibility requirements and appointment-making procedures favor the technologically savvy and well-resourced who can navigate the different systems. Retail pharmacy partners have been reluctant to coordinate their outreach and appointments with state public health officials’ priorities, meaning vulnerable individuals patiently waiting their turn according to health department guidelines could be passed over.’

Continue reading

Certificate of Public Need’s Hall of Mirrors

by James C. Sherlock

Versailles Hall of Mirrors

In Versailles’ Hall of Mirrors, everything is reflected hundreds of times.

The mirrors were also a commercial. They represented an effort of Louis XIV to establish for France monopolies on the production of luxury goods.

Virginia’s Certificate of Public Need (COPN) law and regulations represent a similar structure.

Everything in the process reflects back on itself. Those reflections both reinforce the structure and cement monopolies. Though it represents the intrigue of Versailles, COPN lacks beauty and grace. But, in another similarity, neither Louis nor Virginia’s General Assembly tried to represent the interests of the people in these enterprises.

This essay will help explain how COPN works. It would be shorter if the tentacles of COPN were not so completely enveloping and self-reinforcing. This is in its entirety both legal and a scandal, as with much else in Virginia politics.

Two recent COPN decisions affect my home area of South Hampton Roads. Those cases pointed to the systemic roadblocks to successfully challenging Sentara Healthcare’s dominance here which will never be surmounted while COPN stands as is. Continue reading

Sentara and the Judge

by James C. Sherlock

Updated Feb. 23 at 2:15 pm

In an ongoing series of reports, Ray Locker, enterprise and investigative editor of the Checks and Balances Project, has exposed a story with far-reaching implications.

Norfolk Circuit Court Chief Judge Mary Jane Hall sat in judgment on a case, Chesapeake Hosp. Auth. v. State Health Comm’r,  in which Sentara was an included defendant.  

It appears from that reporting that she could have recused herself for two reasons:

  • prior to her appointment to the bench Judge Hall not only had represented Sentara for years in another COPN case; but also
  • the judge’s co-attorney on that previous COPN case, Jamie B. Martin of Williams Mullin, was Sentara’s attorney in Chesapeake Hosp. Auth. v. State Health Comm’r.

From Mr. Locker’s first article:

The Virginia Canons of Judicial Conduct says this about judicial impartiality:

“(1) A judge shall disqualify himself or herself in a proceeding in which the judge’s impartiality might reasonably be questioned”

Further under Canon 2,

“The test for appearance of impropriety is whether the conduct would create in reasonable minds a perception that the judge’s ability to carry out judicial responsibilities with integrity and impartiality is impaired.”

My own additional research into published Norfolk Circuit Court opinions shows that Judge Hall sat in judgment on cases in that court involving Sentara as well as on Chesapeake Hosp. Auth. v. State Health Comm’r.  This case was filed in Chesapeake Circuit Court.

The Chief Justice of the Virginia Supreme Court, who is charged with overseeing judicial conduct, assigned the case to Judge Hall

Chief Justice Lemons of the Virginia Supreme Court asked Judge Hall to sit by designation in Chesapeake in place of the judges of the First Judicial Circuit (Chesapeake) and hear the case. She accepted. He made the appointment on July 31, 2018.

There would be three possible reasons to import a judge:

  1. Chief Justice Lemons assessed that there were no judges on the Chesapeake Circuit with the experience to hear a COPN case; or
  2. he assessed that the Chesapeake Circuit judges were conflicted or could have been considered so; or
  3. The Chesapeake Circuit had more cases than judges at that point.

There is no indication in the record of why Judge Hall was imported in this case.

Continue reading

COPN – Don’t Leave Home Without It

by James C. Sherlock

Sometimes I think we don’t personalize the effects of Virginia’s Certificate of Public Need (COPN) program on individual Virginians in ways that are relatable. Nor do many understand the power of the hospital monopolies.

Many readers here have followed the progress of our reporting of the increasing and relentless suppression of competition in healthcare by COPN. I will offer in this essay a single example that may personalize it.

In 2009, the regulation, not the law, that defined the radius from your home of facilities that would be considered when seeing whether you are adequately served by existing open heart surgery facilities was changed as follows:

Title 12. Health » Agency 5. Department Of Health » Chapter 230. State Medical Facilities Plan » Part IV. Cardiac Services

Article 2
Criteria and Standards for Open Heart Surgery

12VAC5-230-440. Accessibility Travel time.

A. Open heart surgery services should be within 30 60 minutes driving time one way, under normal conditions, of 95% of the population of a the [ health ] planning district [ using mapping software as determined by the commissioner ].

Simple change. Thirty minutes was changed to 60 minutes. You surely did not notice. You were meant not to notice. And your elected representatives were not asked to vote on it. Continue reading

Certificate of Public Need – This Seems Promising

by James C. Sherlock

Democrats, the primary bulwarks for the Certificate of Public Need (COPN) law in Virginia, took the opportunity last year to create as part of a major revision to COPN law a new 19-member State Health Services Plan Task Force.  

That group is to advise the Board of Health on the content of the newly renamed State Health Services Plan (ex-State Medical Facilities Plan (SMFP).

I wish the task force luck.  They will need it.

The new task force is apparently a temporary casualty of COVID-19, but it shows how desperate the Democrats (read hospitals) are to revitalize COPN after a 2019 Chesapeake Circuit Court decision and supporting appeals court decision in Chesapeake Hospital Authority d/b/a, etc. v. State Health Commissioner and Sentara Hospitals.  

Both decisions exposed it for what it is — a regional monopoly protection racket that is subjectively applied — and found the administration of the COPN system in Virginia to be incompetent at the same time. Continue reading

Bacon Bits: Fear and Loathing at Every Turn

Minutes away from monthslong blackouts. Partisans and their friends in the media will debate forever how to apportion the blame between renewables, natural gas and other factors in the rolling blackouts in Texas. What the situation in the Lone Star State indisputably does do, however, is drive home the absolute necessity of maintaining an electric grid that can withstand rare but extreme weather events. As terrible as conditions are now, with people now going without water and power, it could have been worse. According to officials with the Electric Reliability Council of Texas or ERCOT, the power grid was “seconds and minutes” away from catastrophic failure that could have left Texans in the dark for months, reports The Texas Tribune. Anyone who does not think the same thing could happen in Virginia as we hurtle toward a zero-carbon (and potentially zer0-nuclear) energy grid is homicidally naive.

More news you’ll never read in a Virginia news outlet. We have to rely upon New York-based National Review magazine for this revelation: “While Virginia’s teachers unions have been vocal regarding their worries about returning to school, and their disapproval of the school reopening bill (SB 1303), new documents obtained by National Review show the unions also have engaged in an intense behind-the-scenes pressure campaign to influence Democratic state lawmakers over the reopening issue. Over just the past few months, the unions have combined to send thousands of emails to Democratic House delegates about school-reopening plans. And so far, the lawmakers have refused to release the vast majority of the emails, citing a state law that allows them to shield their correspondence from the public.” (Hat tip: TooManyTaxes)

Healthcare consolidation continues apace. Bacon’s Rebellion is the only publication in Virginia that is worried about the ongoing consolidation of the healthcare industry. The public doesn’t seem to care either, but we’re going to document the trend anyway. The latest news is that the University of Virginia Health System has signed a letter of intent to buy out Novant Health U.Va. Health System, a Northern Virginia regional health system owned and operated by the two companies since 2016. Winston-Salem, N.C.,-based Novant owns 60% of the health system. Under the deal, UVa Health, which owns 40%, will own the whole kit and caboodle. Continue reading

Foy on Healthcare Reform: More Price Transparency

Jennifer Carroll Foy

by James A. Bacon

Judging by his campaign fund-raising e-mails, Terry McAuliffe thinks he can snag the Democratic Party nomination for governor by running against the Republican’s poll-leading candidate, Trumpette Amanda Chase. Given his name recognition as a former governor, that may work. But give his lesser-known rival for the nomination, Jennifer Carroll Foy, credit for talking serious public policy.

Foy’s missive on health care probably won’t garner much attention from the media, which prefers political catfights over debates of substance, and it may not win over many voters. After all, how many voters read public-policy white papers? Her position paper won’t even win over me — Foy’s natural instinct is to turn to government to solve every problem. But at least the former Prince William County delegate has given serious thought to improving Virginia’s healthcare system. And at least one of her proposals — to improve price transparency — is something that even small-government, free-market conservatives can work with.

Rather than dwell on her proposals to establish a prescription drug affordability board, steer funds into a Virginia Reinsurance program, and initiate a half-dozen programs to spend more money, permit me to focus on the Big Idea that has the potential to build bipartisan consensus. Continue reading

All According to Plan – the Biggest Government Scandal in Virginia History

by James C. Sherlock

The Virginia Mercury published  an excellent article on the difficulties being encountered in Virginia in scheduling COVID shots.

But who could have anticipated the need? Who indeed.

This story is part of the single biggest government scandal in Virginia history and the press is either ignorant of the underlying issue or has ignored it. I think ignorance is more likely. Certainly Governor Northam’s executive branch made every effort to hide it from them.

I say the executive branch because I firmly believe — and hope really — the Governor himself never had a clue.

The now-hidden-from-public-view Commonwealth of Virginia Emergency Operations Plan, Hazard-Specific Annex #4 Pandemic Influenza Response (Non-Clinical), Virginia Department of Emergency Management August 2012 (the Plan) required planning and exercise of a vaccine distribution plan and much more.

Never happened.

The Plan specified planning, exercise and operational responsibilities for
the following executive branch organizations: Continue reading

Carilion Takes a Crack at Reforming Hospital Billing

by James A. Bacon

Just as they’re borrowing billions to pay for college, and automobiles, and credit cards, and houses, Americans are borrowing billions to pay for their share of healthcare costs that their insurance doesn’t cover — $88 billion, according to a 2019 Gallup poll. Adding insult to injury, Americans are subjected to a bewildering blizzard of paperwork from insurers, doctors, and hospitals.

Two years ago Roanoke-based Carilion Clinic, the healthcare system that serves more than a million people in western Virginia, knew it had a problem. More than half the health system’s patients wanted to pay off their hospital bills monthly, but 28% could afford no more than $250 a month.

“We realized that we did not have the technology in place to meet our patients’ and their families’ expectations in today’s environment,” said Don Halliwill, Carilion CFO in a Visitpay white paper, “Why CFOs Should Start Thinking Like Patients.”

The white paper describes how Carilion partnered with Visitpay to overhaul its patient billing process. Needless to say, the Visitpay paper puts a positive spin on the solution it devised to help Carilion. I don’t write about it here to tout the solution, but rather to suggest that there are better ways to do things. In Virginia, hospitals have come under intense criticism for antiquated and confusing billing and abusive collections practices. Carilion provides one possible model — I make no endorsements — for taking some of the pain out of the process. Continue reading

More Vaccination Confusion

By Dick Hall-Sizemore

I do not know who is to blame–CVS or the state–but the vaccination situation is unacceptable.

The Commonwealth seemed to be getting on the right track by enabling individuals to register with their local health departments and the local agencies then using those registration to schedule appointments.

Then the federal government changed things by announcing that the vaccines would be distributed through private pharmacies.

That could have worked well. The local agencies would take registrations centrally and then work with the designated CVS store to schedule the vaccinations. That is sort of what was reported was going to happen. But CVS said that folks would have to register with its stores, but it would give priority to those on the health department registry. Continue reading

Medicare for All – A Cautionary Tale

The Business of Healthcare

by James C. Sherlock

For those of you who think “Medicare for All” would be a good thing, I offer a cautionary tale from Becker’s Hospital CFO Report titled Hospitals barred from suing over $840M pay cut.

A group of more than 680 hospitals can’t revive a lawsuit saying they lost $840 million in payments because of adjustments made by federal regulators to make up for a Medicare shortfall, according to Bloomberg Law.

On Feb. 9, the U.S. Court of Appeals for the District of Columbia held that federal law bars the hospitals’ lawsuit. At issue was whether HHS unlawfully extended a program to make up an $11 billion Medicare shortfall.

Continue reading

Virginia’s Legendary Corruption Blocks Antitrust Enforcement

Great Seal of Virginia

by James C. Sherlock

Readers of this blog have indicated an unquenchable appetite for information about and discussion of Virginia’s Certificate of Public Need (COPN) law and its administration.

This essay informs on the negative impacts of the COPN law and the Virginia Antitrust Act (the Act) itself on the enforcement of antitrust laws against Virginia’s regional hospital monopolies.

First, know that the business activities that some of Virginia’s hospital monopolies exhibit can already be deemed illegal under both federal and state antitrust laws. But the Act gives them a special dispensation, complicates both state and federal antitrust enforcement and results directly in the in-your-face anticompetitive activities we see every day.

The federal government (and once even Bob McDonnell as Virginia Attorney General) occasionally have intervened to block interstate mergers or in-state acquisitions before they occur, but always within the federal administrative and court systems, and they have never challenged COPN decisions.

But no government agency has ever sued over the business activities of Virginia’s COPN-constructed monopolies. Continue reading